More of us than ever are taking statins. The National Institute for Health and Care Excellence (NICE) reported in October 2024 that around 5.3 million people in England had taken statins or the cholesterol-lowering medication ezetimibe in the previous year.
That's almost triple the figure for 2015/2016 and approaching 10 per cent of the country's population. Meanwhile, statin use is also increasing globally.
Doctors prescribe statins to help prevent heart disease – currently the leading cause of death worldwide. They reduce low-density lipoprotein (LDL) cholesterol – the ‘bad’ type that clogs up arteries – by interfering with enzymes that our livers use to make cholesterol and helping draw it out of the blood.
This makes statins effective at preventing heart attacks and strokes, but that alone doesn't answer all the questions people have before they decide to start taking drugs like these.
Questions like: if I have high cholesterol, do I have to take statins? Can I try changing my diet and doing more exercise first? And what kinds of side effects can I expect if I do start taking statins?
The answer to the first two questions is the same: It's up to you.
How to decide whether statins are for you
The decision to start taking statins is one you should arrive at with the help of your doctor, and it should be based on your overall risk of heart disease – not just your cholesterol level.
That means considering other risk factors such as your blood pressure, family history and even your postcode.
As Julie Ward, a senior cardiac nurse at the British Heart Foundation, explains, doctors use all this information to calculate your personal cardiovascular risk score, which tells you how likely you are to have a heart attack or stroke in the next ten years.
“Once that cardiovascular risk score comes back, conversations can start about what we can do to reduce that risk,” says Ward. “So, it really is a conversation between the person and the [doctor] or pharmacist. It’s not just, ‘This is your cardiovascular risk. We’re going to start you on a statin.’”
That conversation might start with lifestyle changes, such as eating more healthily or stopping smoking. You can calculate your risk score using an online calculator, such as this one. The higher your ten-year risk, the more likely that statins will be up for discussion.
You might decide your risk is low enough to warrant a diet and exercise plan instead, before revisiting the calculator a few months later to see if it’s changed. But what if statins are strongly recommended?
Statins are safe and effective
It’s understandable to feel apprehensive about starting a drug you might have to take for the rest of your life.
But here the science may provide some reassurance, because there’s a wealth of evidence showing statins are effective for preventing heart disease – and with only mild side effects, according to Prof James Sheppard, a health data scientist at the University of Oxford.
“Statins are probably the most widely studied drugs in medical history,” he says. “There are hundreds and hundreds of clinical trials looking at statins.”
Researchers have also pulled together the results of large collections of these trials to help strengthen the evidence.
In 2015, for example, researchers working for Cochrane, a world-renowned publisher of medical reviews, pooled data from nearly 39,000 people who took part in 296 trials on atorvastatin, the most widely prescribed statin.
Overall, their review showed that taking atorvastatin for up to 12 weeks decreased LDL cholesterol by 37–52 per cent, depending on the dosage.
But how much does taking a statin reduce your risk of dying from a heart attack or other cardiovascular cause? Well, that depends on who you are.
A review of clinical trials published in early 2025 puts the figure at anywhere between 20 and 62 per cent, with the higher figure being for higher-risk groups. These are good reductions from drugs that cost less than £2 (approx $2.50) per 28 tablets.
We still need to be careful about how we interpret the figures for our own decision-making, however.
In large trials, the effects are often reported in relative terms, meaning they reflect the difference compared to not taking a statin.
But, as Sheppard points out, “What’s important when you’re thinking about who you should treat in the real world is the absolute risk.”
So, for example, if taking a statin reduces the risk of having a heart attack by 20 per cent, for someone whose absolute risk (or cardiovascular risk score) is only 1 per cent, taking a statin would only reduce their risk from 1 to 0.8 per cent.
Someone with a risk score over 10 per cent could see much bigger benefits, however.
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Side effects may vary
So, we know statins work, but what about the bad press surrounding their side effects?
“Press coverage in the past has tainted a lot of people’s views,” admits Ward. “But through the research, we know that side effects are minimal and statins are extremely well tolerated in the general population.”
This is what Sheppard and his team found in a study they published in 2021. They looked at adverse effects from statins across 62 trials, involving more than 120,000 people, and found that only a “tiny number” reported any at all.
Around 15 in every 10,000 people experienced pain or other symptoms associated with muscles, while liver, kidney and eye problems were even less common.
Yet we know that when people stop taking statins, it’s often due to side effects. So, what’s going on?
Another 2021 study suggests those side effects may have more to do with our negative associations with taking a pill than with what’s actually in it.
In the study, 60 people were given 12 one-month supplies of medicine – four bottles with statins, four with dummy pills (placebos) and four with nothing in them. But they didn’t know which were statins and which were placebos.
After a year of tracking the participants’ symptoms, the researchers found that people did experience more symptoms when they were taking a pill compared to nothing, but that 90 per cent of the symptoms from statins also occurred with placebos.
It may help to change your dosage or pill
Of course, that’s not to say that if you experience a side effect, you should just grin and bear it. Ward instead suggests you try asking your doctor to adjust the dosage.
Atorvastatin, for example, can be given in doses ranging from 10–80mg per day. As side effects tend to be dose-related, 80mg is more likely to cause a problem than 10mg, but wouldn’t necessarily be a long-term dosage.
“If somebody has high cholesterol levels, we might start them on 80,” says Ward. “Months later, if they’re doing great, we can get it down to 40 and then, in a year's time, maybe even 20 or 10, which is called a maintenance dose. And you're very unlikely to have side effects at 10 or 20mg."
Another option is to change pills. Five statins are available on prescription in the UK and although they all work in similar ways, atorvastatin is considered the best.
“So, if you were taking a different type of statin at a higher dose, a doctor could prescribe atorvastatin at a lower dose,” says Sheppard. “[That] might give you similar cholesterol-lowering effects with fewer side effects.”
On rare occasions, taking statins can have more serious side effects on the liver and kidneys, but anyone taking statins should have regular blood tests to check for these.
People with diabetes may also be concerned about new research showing that statins can raise blood sugar.
The beneficial effects of lowering cholesterol are thought to outweigh the harmful effects of slightly increased blood sugar though.
Ultimately, taking statins is a personal decision. If you’re worried about it, consider speaking to a cardiac nurse at the British Heart Foundation or exploring Heart UK’s resources on cholesterol.
About our experts
Julie Ward is a senior cardiac nurse at the British Heart Foundation.
Prof James Sheppard is a health data scientist at the University of Oxford, in the UK, with a research focus on cardiovascular disease prevention. He is published in the likes of British Journal of General Practice, BMC Medical Research Methodology and BMJ Open.
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